Role of Hepcidin on Response of Erythropoietin Stimulating Agents in Anaemic Advanced Chronic Kidney Disease Patients OC14-OC16
Dr. Satyendra Kumar Sonkar,
Professor, Department of Medicine, King Georgeâ€™s Medical University, Lucknow-226003, Uttar Pradesh, India.
Introduction: Anaemia contributes significantly to the morbidity and mortality in Chronic Kidney Diseases (CKD). Erythropoietin Stimulating Agents (ESA) have revolutionised the management of the anaemia in CKD patients. However, over 50% of the patients do not reach the target haemoglobin level. Hepcidin which plays important role in iron metabolism and inflammation may be the cause of this hyporesponsiveness to ESA.
Aim: The present study was aimed to assess possible relation between hepcidin and erythropoietin therapy with special attention to hyporesponsive anaemia in advanced kidney disease.
Materials and Methods: In this cross sectional study, total of 81 clinically stable patients from Department of Medicine and Nephrology, King Georgeâ€™s Medical University, Lucknow of advanced CKD on ESA for past 12 weeks were enrolled. Patients whose haemoglobin rose more than 2 gm/dL or were above 10 gm/dL were classified as responders while below 10 gm/dL were classified as poor responders.
Results: In present study, majority 54 patients (66.7%) were poor responders to ESA. We found significant higher level of hepcidin in poor responders (p=0.01) while no significant variation in serum iron, Transferrin Saturation (TSAT) and ferritin. High sensitivity C-Reactive Protein (hsCRP) was markedly elevated with median value 3.13 mg/L and Interquartile Range (IQR) (1.14-13.78) in all patients.
Conclusion: Hepcidin may be one of the causes of hyporesponsiveness to ESA due to reticulo-endothelial blockade of iron.